Comprehensive long-term management program for asthma: effect on outcomes in adult African-Americans.

To determine if a comprehensive long-term management program, emphasizing inhaled corticosteroids and patient education, would improve outcomes in adult African-American asthmatics a nonrandomized control trial with a 2-year intervention was performed in a university-based clinic. Inclusion criteria consisted of (> or = 5) emergency department (ED) visits or hospitalizations (> or = 2) during the previous 2 years. Intervention patients were volunteers; a comparable control group was identified via chart review at hospitals within the same area and time period as the intervention patients. Individualized doses of beclomethasone with a spacer, inhaled albuterol "as needed," and crisis prednisone were the primary therapies. Environmental control, peak flow monitoring, and a partnership with the patient were emphasized. Detailed patient education was an integral part of management. Control patients received usual care from local physicians. ED visits and hospitalizations for 2 years before and 2 years during the intervention period were compared. Quality of life (QOL) measurements were made at baseline and every 6 months in the intervention group. Study group (n = 21) had a significant reduction in ED visits (2.3 +/- 0.2 pre-intervention versus 0.6 +/- 0.2 post-intervention; P = 0.0001). Control group (n = 18) did not have a significant change in ED visits during the 2-year post-intervention period (2.6 +/- 0.2 pre-intervention versus 2.0 +/- 0.2 post-intervention; P = 0.11). Both groups had significant reductions in hospitalizations, but the study group had a greater reduction. Sixty-two percent of study patients had complete elimination of ED visits and hospitalizations, whereas no control patients had total elimination of the need for institutional acute care. QOL in the study patients revealed significant improvements for most parameters. A comprehensive long-term management program emphasizing inhaled corticosteroids combined with other state-of-the-art management, including intensive patient education, improves outcomes in adult African-American asthmatics.

Reassessing the therapeutic range for theophylline on laboratory report forms: the importance of 5-15 micrograms/ml.

The therapeutic status of theophylline has changed dramatically over the last decade. As part of this change, a different view of the most appropriate therapeutic range for serum theophylline concentration (STC) has emerged. The National Institutes of Health Expert Panel Report, "Guidelines for the Diagnosis and Management of Asthma," suggests a conservative approach of aiming for STC of 5-15 micrograms/ml. This truly landmark document along with several studies in the literature, recently prompted us to change our hospital's laboratory report form for the medical record to read that the therapeutic range for STC is 5-15 micrograms/ml. We encourage hospital laboratories or other clinical laboratories who have not already made this change to do so.